Americans who relied on the drug Vioxx for pain relief do have alternatives, doctors say. Just no perfect ones. In the wake of the abrupt withdrawal of Vioxx from the marketplace, physicians across the country have been flooded with phone calls from anxious patients worried about possible stroke risk and damage to their hearts -- and what they could use instead. "We couldn't handle anything else for hours," said Dr. Daniel J.

When Dr. Darlyne Johnson, 46, found out three years ago that she needed hernia surgery, she balked. "I knew what was going to happen -- I'd get sick." Each time Johnson has had surgery over the years, she's wound up with such terrible nausea and vomiting from painkillers that she had to stay in the hospital overnight. This time, however, she heard about a device called ON-Q.

Federal prosecutors launched one of their highest-profile and most controversial assaults in the war against prescription drug abuse recently when they indicted Dr. William E. Hurwitz, a 57-year-old Virginia pain treatment specialist. Hurwitz, a Stanford University medical graduate who also has a law degree, was depicted as a "street-corner crack dealer" by federal officials during a court hearing last month. He remains in a Virginia jail, unable to post bail set at $2 million.

After a three-year battle with leukemia, Dennis Shearer was so weak he couldn't stand. The 52-year-old landscaper's lungs filled with fluid, his breathing grew labored, his liver began to fail and severe intense pain kept him awake at night. He died in agony in 1999. Although his illness was terminal, his physicians insisted on heroic measures to keep him alive. "I begged his doctors to put him on a continuous morphine drip," recalls his widow, Paula Getty-Shearer of Chatsworth.

Riddled with pain from rheumatoid arthritis and a degenerative bone disease for years, Diana Rose rarely left the house. Then in November, a doctor prescribed the painkiller OxyContin, dramatically changing her quality of life. "I can actually go shopping at the mall, play with my grandchildren and even swim in our pool," said Rose, a 57-year-old Kentucky woman. "This drug has enabled me to do things without being in pain."

In a decision that could improve how seriously ill Americans are treated for pain, an Alameda County jury ruled that a physician was guilty of elder abuse for failing to give a dying man sufficient medication to relieve his suffering. The Hayward jury ruled Wednesday that Dr. Wing Chin must pay $1.5 million to the children of William Bergman, who died of lung cancer in 1998 at the age of 85. Chin declined to comment on the case.

"Painfully Deceitful" (editorial, Sept. 17) did not paint an accurate picture of the Pain Relief Promotion Act. The American Medical Assn. is committed to providing the best pain relief for patients at the end of life, and this bill creates an environment in which physicians may administer appropriate and aggressive pain care for patients. This legislation would not expand the authority of the Drug Enforcement Administration, and in fact would for the first time legally recognize the "double effect," the fact that aggressive pain treatment may carry with it the potential for increased risk of death.